Studies show home-based hospital acute care results in fewer medical laboratory and diagnostic tests

Home-based hospital care (HBHC) is a care delivery model that is evolving at a rapid pace. To be effective, HBHC must improve patient outcomes while avoiding the expenses associated with an inpatient stay at a hospital.

However, significant growth in the number of patients treated in home-based hospital care programs would directly affect hospital-based clinical laboratories and pathology groups. Among other things, this would reduce the volume of inpatient testing while increasing the number of outpatient/outreach specimens.

Evidence is accumulating in favor of HBHC. New research shows that a New Mexico home-based hospital care (HH) program demonstrated cost savings and equal or better patient outcomes and patient satisfaction for acutely-ill patients compared to similar patients receiving in-hospital care. These new findings affirm similar results from a 2005 study of HBHC.

Hospital-At-Home Programs Are Refashioning Traditional Care Approaches

According to a recent story published in USA Today and reported by Kaiser Health News, HBHC programs are expanding traditional models for treating the acutely-ill. Continuing pressure from health reform to improve the quality of medical care and lower costs is focusing more attention on these programs.

Early pilots of home-based hospital care (HBHC) programs are producing impressive improvements in patient outcomes while directly reducing the cost of care to the patients. This is a new care model that, if widely-accepted, would tend to reduce the volume of inpatient testing for hospital laboratories while increasing the proportion of specimens originating from outpatient and outreach HBHC care settings. (Photo by Eldercarechannel.com.)

“Hospital at Home is an excellent model of care that can be implemented in a practical way by health delivery systems across the country,” stated Bruce Leff, M.D., Director of Geriatric Health Services Research and Professor at Medicine at Johns Hopkins University School of Medicine, in a university press release.

Leff developed the Hospital at Home model at Johns Hopkins. He led the recent study, which was published in the June issue of the journal Health Affairs.

Leff observed that high-quality clinical HBHC programs represent what healthcare reform seeks to achieve: delivery of efficient, cost-effective, and individualized patient-centric care.

Albuquerque, New Mexico-based Presbyterian Healthcare Services worked with Leff to develop a home-based care program adapted from the Johns Hopkins Hospital at Home® model. Leff and his co-authors made these points in the study abstract.

The year-long study involved 323 patients who were sick enough to require hospitalization, but who opted instead for home-based hospital care. The researchers compared those patients with 1,048 hospital inpatients, noted the Johns Hopkins press release.

The most common diagnosis for both groups was pneumonia. Other conditions included congestive heart failure, cellulitis, deep vein thrombosis, pulmonary embolism, urinary tract infection, nausea, vomiting, and dehydration.

The HBHC patients lived within a 25-mile radius of an emergency department run by Presbyterian. All the homes met validated medical eligibility criteria to ensure patient safety. The patients received daily physician visits for medical care, diagnosis, and care plan coordination. Nurse visits occurred once or twice daily. Some of the nurse duties included:

• patient assessment,
• conducting routine clinical laboratory tests,
• administering infusions and other medications, and
• performing ordered care procedures.

The New Mexico Presbyterian program achieved cost savings of 19%, compared to similar hospital acute care patients, the abstract stated. For the most part, the savings derived from shorter average length-of-stay. The HBHC program also generated fewer medical laboratory and diagnostic tests.

This is consistent with previous similar studies. In 2011, Deloitte Access Economics issued a report titled “Economic analysis of Hospital in the Home (HITH).” Deloitte analyzed an Australia study of hospital-in-the-home services. The study affirmed patient benefits, as well as projected average cost savings of 22% compared to in-hospital care. (See Dark Daily, “Australia’s ‘Hospital in the Home’ Care Model Demonstrates Major Cost Savings and Comparable Patient Outcomes”).

In a 2005 study of HBHC programs, also led by Leff and published in the Annals of Internal Medicine, research demonstrated that three experimental home-based hospital care programs produced patient outcomes equal to or better than in-hospital care. Of equal significance, the HBHC program lowered costs by 32% over traditional hospitalization, USA Today reported.

Home-based Hospital Care Gaining Momentum

From all indications, and despite some impediments, the hospital-at-home healthcare delivery model is here to stay. That is despite the fact that only a handful of HBHC programs exist currently.

There are two reasons that pathologists and clinical laboratory managers can expect that to change. One will be the aging population. The other will be the number of patients with chronic disease. That number is projected to double by 2030, according to a story published by The Commonwealth Fund.

“It’s a very successful model, and in five years, I think, it’s going to be very common,” stated Mark McClelland, D.N.P., R.N., Assistant Research Professor at the Center for Health Care Quality at George Washington University, in the USA Today piece. “[W]e’re still in the early adoption phase,” he noted.

The biggest resistance to widespread adoption of home-based hospital care programs comes from physicians who have concerns about safety and Medicare and private insurers, the Johns Hopkins press release noted. Another issue is that traditional fee-for-service Medicare lacks coding for HBHC, USA Today reported. Therefore, the programs are limited to Medicare managed care and Department of Veterans Affairs (VA) health systems.

Despite these limitations, by consistently demonstrating cost savings and patient benefits, home-based hospital care pilot programs are proving that this  care model is destined to gain wider acceptance. As that occurs, it implies decreased volumes of in-hospital clinical laboratory testing—as well as increased home-based specimen collection. For that reason, this is a trend that pathologists and clinical laboratory managers will want to keep on their radar screen.

—Pamela Scherer McLeod

Related Information:

Hospital-at-home programs for intensive-care patients spread

Australia’s ‘Hospital in the Home’ Care Model Demonstrates Major Cost Savings and Comparable Patient Outcomes

Johns Hopkins’ Hospital At Home Program Improves Patient Outcomes While Lowering Health Care Costs

Home Hospital Program: A Pilot Study

Hospital at Home: Feasibility and Outcomes of a Program To Provide Hospital-Level Care at Home for Acutely Ill Older Patients

Costs For ‘Hospital At Home’ Patients Were 19 Percent Lower, With Equal Or Better Outcomes Compared To Similar Inpatients

Hospital at Home Program in New Mexico Improves Care Quality and Patient Satisfaction While Reducing Costs